Provider Demographics
NPI:1841589355
Name:COMFORT PHARMACY INC
Entity Type:Organization
Organization Name:COMFORT PHARMACY INC
Other - Org Name:COMFORT PHARMACY 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSARHIEME
Authorized Official - Middle Name:
Authorized Official - Last Name:IGBINOBA-OKOJIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-296-4566
Mailing Address - Street 1:5529 REDAN CIR STE B
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-3411
Mailing Address - Country:US
Mailing Address - Phone:678-694-8836
Mailing Address - Fax:678-694-8839
Practice Address - Street 1:5529 REDAN CIR STE B
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-3411
Practice Address - Country:US
Practice Address - Phone:678-694-8836
Practice Address - Fax:678-694-8839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332100000X, 332B00000X, 333600000X, 3336C0004X
GAPHRE0097533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332100000XSuppliersDepartment of Veterans Affairs (VA) Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003119712AMedicaid
2129866OtherPK